The URL can be used to link to this page

Home My WebLink About0236 BEARSE'S WAY - Health 236 pi4rses-Way, _;Hyannis A �y a ,r l� 0 0 z .. Commonwealth of Massachusetts 0)CT Exe_ cutive Office of Environmental Affairs 11r999� Department of � Environmental Protection E n William F.Weld $ Governor Trudy Coxe Secrel",EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: a s:ax5bx�>af1�c't)ityvt5�(�p, Address of Owner: �`��•N��kS D. of Inspection: 1t>`aa(5�. (I( different) Name of Inspector: HreVuk_l D-aTZ>ecVt Company Name, Address and Telephone Number: fiZ�.yv.Tst�.rrrei,viw—cr�1.��G.•jr;�2�^v'-It 4'�i�S��CI�"�Q•02L4�� ' CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below• is true, accurate and complete as-of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. l he system: Passes _ Conditronall)• Passes Needs Further Evaluation By the Loc;l Approving Authority _ Fails Inspector's Signature: . I Date: Aaa The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flos\ of 10,00() gpd or greater, the inspector and the system owner shall submit the report to the approprialc recional office of the D.eparrUncnl of Environmental Protection. the oriEu,:rl shuuld be scnr ; r. >\strrr, v •firer aura whii> :_ iv t'•� b,rr�:, if aNi,:jcal,:c anc! the approving aulhority. INSPECTION SUMMARY: Check n, B, C, or D A) SYSTEM PASSES: _ I have not found any information which indicates that the system violates any of the failure criteria as defined in;310 CMR 15.303. l Any failure criteria not evaluated are indicated below. Bt''.SYSTEM CONDITIONALLY PASSES: µ One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, _ r passes inspection. Describe basis of determination�in all instances. If"not determined", explain why not) Indicate yes, no, or not determined (Y, N, or ND). _ The septic lank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 0/15/95) Ono Wln►or Street • Boston, Mnssricliusetts 02100 • FAX(617) 556-1049 • Telephone (617)292-5500 V.1 Prinrcd an R.ry ycird P,µcr r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Dale of Inspection:ttJWA-%s BJ SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of(lie Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced a _ ng more than four times a year due to broken or obstructed pipe(s). The system willpass The sys(en, required pumpi inspection if (with approval of(he Board of Health): broken pipe(s) are replaced obstruction is removed OARD OF HEALTH: Cl FURTHER EVALUATION IS REQUIRED BY THE B Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing (o protect the public health, safely and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feel of a surface water Cesspool or privy is within 50•feet of a bordering vegetated wetland,or a salt marsh. 2) SYSTEr,t 11'ILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENNT: !.. 1. ;:.... lui >li,n, i ,:- ,i >Pl u� Idnti dnu ,uii eUti��NUuu S)'�iein "hi i .. ; , 4 v0 fii; lv u Sl:fu�y ::a;c: SUjiN•, 0: l:i l surface ��atri supph. 1 he s�ur n� h.�• c� �epiic tank and soil absorption system and is within a Zone I of a public water supply well. _ The syslr•m h•1� a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The s,l-q,jil I',', ;% `vp; t: tank and soil absorption system and is less than 100 feet but 50 feet or more from a private ��tcr _ supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Z (revised 8/15/95) ! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propert Address: ; 141}a"fAXt1+ 4YK'Pl5 Owner: jy Date of Inspection:(4t4e'(5 DJ SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is.less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feel of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. ` Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: i The design flo++ of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one.or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary 10 a surface drinking water supply the +y5ten'. is located ur a nitrogen sensitive area (Interim Wellhead Prolection Area (IWPA) or a mapped Zone II of a public ++dter supply' \%Tll' The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. r (revised 9/15/95) 3 I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly ddress: _bMvt esWel It�vw ks Owner: Dale of Inspection: 1 IG� 4� �L��LLL1111 \ Check i(Ilic following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the systen, components have been pumped for at least two weeks and the system has been receiving normal flow rites during that period. large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are nol available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow /_The site vas inspected fol signs of breakout.. All systen, components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes Were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or a171/ru\imatpd I,V nun-n,uu>i�C mCtixdr. ,,. :I.• I i; r•..••,• nv. wn n provided with information on the prover maintenance of Sub- .......Disposal System. . I _ I (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Dale of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: ?0 _gallons Number of bedrooms:_ Number of current residents:GI Garbage grinder (yes or no):NU Laundry connected to system (yes or no)qe i Seasonal use (yes or no):tJ Water meter readings, if available: Last'date of occupanc 1 COMMERCIAUINDUSTRIAL: , Type of establishment: Design flow: gallons/day. Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ i Water meter readings, if available: I Last date of occupancy: OTHER: (Describe) Last (late of Occupanc)': GENERAL INFORMATION PUMPING.RECORDS and source of information: J - �`C1N�L�'Jpululca� �s�� Syst m pumped as (,an of inspectoon: (yes or no)_ If yes. volume w-l!w,! -----F•alions Reason for pumping. TYPE OF SYSTEM - Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy r -r , Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) rtr. Sw..��,szz �x (o (`� 4- -o •�c� e7�1�Q�\ , ('�� ,r�cc� �C to , APPROXIMATE AGE of all components, date installed (if known) and source of information: o o� 1s },,c�`�y� -n G NU.: ,��..�5:c.ASL�t� ✓�t'ti i` �j�' l L; �:ws c� orJ pb ;� \O A Owl'-� t S�1W r�i 1(7�1 Bl Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 i r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEMINFORMATION (continued) Property Address: a3b co�� 1,x�>—ts^rN►J•S Owner: �ftL�e,iL<j V Dale of Inspection: I�.A S SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) �• Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet lee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle:u Distance from bottom of scm to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of 'inlet and outlet tees or baffles, depth of liquid level in relatioR•to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete metal _FRP —other(explain) Dimensions: Sllll l} Ilu�l.11�_>. Distance from top of scum to top of outlet tee or baffle: rl i,tan, Irom how— r . i ^• I'• I,nII„n• r ' IIP'vl 11•' O' h�llll<•' Comments: (recommendation for purnpinc. cundll,on of inlel and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakilec• e1c.1 � 1r (revised 8r'!5/95) 6 • I i r i I � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Tt'i A<s Date of Inspection: Ic, lr,s TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: gallons Design floe': gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locale on silo plan. Depth of liquid level above pulls( invert: ' Comments: , (null' it Il•\e; iu,'i liimi.u... 1ii . ��•�• ��•• • , e'•i-1cjcc o! l.cal:age into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 • I , i - 7' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Proper_ ddress: Owner: Date of Inspection: IQIZ)�S SOIL ABSORPTION SYSTEM (SAS):_)L (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,lenglh: leaching fields, number, dimensions: overflow cesspool, number:_ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetalion,etc_) CESSPOOLS: �C (locate on site plan) Number and configuration: vi U.Nak 1l Depth-top of liquid to inlet j wert: � Depth of solids layer: 'l Depth of scum layer: U Dimensions of cesspool: \ Nialerials of construction: II,,:<a:iu:. o` [:o.:: cf...a,r.. �u) rf f �✓ J inflow (cesspool must be pumped as part of inspection) Comm nls: (note condition of soil, sr nc of h draulic failure, level of onding condition ve elation, etc T eMA PRIVY: (locate on site plan) r- Materials of construction: Dimensions: • Depth of solids: • Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) B I I r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ' Property Address: Owner: Dale of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locale all wells within 100' (93 `r . (,,XL (P-" G/ O �S�YA\ � O IvCJO qA t OVC2F�(.W (0 I -c-06 2 ' 3 141 t�VGCFIuw 'F� DEPTH TO GROUNDWATER Depth to groundwater: 00 30 feet d� method of determination or approxiimtion: �Ud ��c- ,� �, � Out p. wr � cI ( INam . T�� t ��" Lo t' �� (revised 8/15/95) 9 Atlantic Enviromental Attn: The Commonwealth of Massachusetts Town of Barnstable Board of Health 367 Main Street Hyannis,Ma.02601 From: Mr Michael DeDecko Atlantic Enviromental P.O.Box 2384 Mashpee,Ma 02649 Dear: Board of Health Official, 1 certify that I have personally inspected the sewage disposal system at 236 Bearses Way,Hyannis,Ma. and the information reported is true, accurate and completed as of the time of inspection.I have not found any information which indicates that the system fails to adequately protect. public health or the enviroment. If you have any questions regarding this inspection. feel free to contact me at (508) 477-1420 Thank You Si cerely Michael DeDecko TOWN OF BARNSTABLE I:CiCAT1ON_�3�oSEWAGE .# VILLAGE_'VA Y4ANe'i j -- ASSF,SSUR'S MAP fa LOT alb- D3a li INSTALLER'S NAME & PHONE NO. �1A`P�' LAt4%0 S'V�-0Tk C SEPTIC TANK CAPACITY�_ LEACHING FACILITY:(type) PV e G ASC 427r- (size) LC�9 w1� NO. OF BEDROOMSPRIYATE WELL 4a U13L1C BUILDER OR OWNER_ DATE PERMIT ISSUED:__ _ DATE COMPLIANCE ISSUED__ VARIANCE GRANTED: Yes_ --.,No- �-� _��__— . WWW